摘要:

The recognition of the microbial originand the specificity of periodontal infections has resulted in the development of several adjunctive therapies (antibiotics and/or antiseptics) to scaling and root planing in the treatment of chronic adult periodontitis. This article aims to review the “additional” effect of a subgingival irrigation with chlorhexidine, or a local or systemic application of tetracycline or metronidazole, performed in combination with a single course of scaling and root planing in patients with chronic adult periodontitis. All treatment modalities are compared with scaling and root planing, based on their impact on: the probing depth (PD); total number of colony forming units per ml (CFU/ml); the proportions and/or the detection‐frequency ofActinobacillus actinomycetemcomitans, Porphyromonas gingivalis, andPrevotella intermedia; and/or on the percentages of cocci, spirochetes, motile, and other microorganisms on dark field microscopy examination. All treatment modalities, including scaling and root planing without additional chemical therapy, resulted in significant reductions in the probing depth and the proportions of periodontopathogens, at least during the first 8 weeks post‐therapy. However in comparison to a single course of scaling and root planing, the supplementary effect of adjunctive therapies seems to be limited. In general, only the irrigation with chlorhexidine 2%, the local application of minocycline, and the systemic use of metronidazole (in case of large proportions of spirochetes) or doxycycline (in case of large proportions ofA. actinomycetemcomitans) seem to result in a prolonged supplementary effect when compared to scaling and root planing. Therefore, the use of antibiotics on a routine basis, especially in a systemic way, in the treatment of chronic adult periodontitis, can no longer be advocated, considering the increasing danger for the development of microbial resistance.J Periodontol 1996;67:1143–1158.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1143

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

This retrospective study compares the short‐term(1 year) and long‐term (2 to 5 year) clinical results of regenerative therapy in clinical private practice using a bone allograft for the treatment of intrabony defects in smokers and non‐smokers. A total of 110 intrabony lesions were treated with demineralized freeze‐dried bone allograft (DFDBA) following thorough defect debridement and root preparation in 53 patients (15 cigarette smokers and 38 non‐smokers). Assessments of clinical attachment level (CAL) and probing depth (PD) were recorded at pre‐treatment, 1 year post‐treatment, and 2 to 5 years post‐treatment. At 1 year post‐treatment, significant gains in mean CAL were maintained for both smokers (2.7 mm) and non‐smokers (3.4 mm). Similarly, significant reductions in mean PD were observed for smokers (3.0 mm) and nonsmokers (3.8 mm) at the 1‐year follow‐up. However, when comparing relative improvements in clinical measures, smokers were found to exhibit significantly poorer treatment results (i.e., sites exhibited less CAL gain) at 1 year and 2 to 5 years followup. Relative to pre‐treatment scores, differences in improvements observed for CAL at the 1‐year evaluation (29.2% for smokers and 42.5% for non‐smokers) were sustained in the subgroup of patients at 2 to 5 years follow‐up (31.3% for smokers and 41.8% for non‐smokers). Similar but non‐significant trends were observed for relative reductions in probing depth for smokers and non‐smokers at 1 year (41.9% for smokers and 49.3% for non‐smokers) and 2 to 5 years follow‐up (43.9% for smokers and 48.3% for non‐smokers) for the subgroup of patients followed beyond 1 year. These results suggest that smoking adversely affects treatment outcome, as measured by gains in clinical attachment levels of intrabony defects treated by regenerative therapy using DFDBA.J Periodontol 1996;67:1159–1163.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1159

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Periodontal probes have previously been shownto harbor several bacterial types or species after probing periodontally diseased pockets. This study aims to identify and quantify periodontopathogens that may adhere to a periodontal probe by culturing techniques. It also examines the probe's roughness on its capability to collect bacteria, comparing Merrit‐B probes (with deep indentations) with TPS probes (with smooth surfaces). From the differential phase contrast microscopy findings it was seen that, while paper‐points harbored nearly 50% motile rods or spirochetes, the periodontal probes were just at, or below, the 20% threshold level for pathogenicity (23.6% for the Merrit‐B probe and 11.3% for the TPS probe). The cultural data showed that paperpoints had significantly higher (P<0.05) numbers of anaerobic bacteria than the 2 probe types, which still harbored up to 107CFU. No significant differences could be detected between the probes. When specific periodontopathic species were considered, it was seen that for all species, even forActinobacillus actinomycetemcomitansorPorphyromonas gingivalis, the detection frequency was comparable for the 3 sampling devices. However, the levels ofPrevotella intermediaandCampylobacter rectuswas significantly higher in samples from paper‐points (P<0.05), but still their numbers reached even 105on the probes. Differences among the 2 probe types were again negligible. Periodontal probes harbor relatively high numbers of bacteria found in periodontal pockets and may be able to carry them over to other sites. Further studies are needed to determine if, and to what extent, transmission occurs during periodontal probing.J Periodontol 1996;67:1164–1169.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1164

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Chitosan, with a chemical structuresimilar to hyaluronic acid, has been implicated as a wound healing agent. The purpose of this research was to evaluate the effect of chitosan on Osteoblast differentiation and bone formation in vitro. Mesenchymal stem cells were harvested from fetal Swiss Webster mice calvariae prior to osteoblast differentiation and calcification (12 to 13 days in utero). Stem cells were seeded into 6‐well culture plates at a density of 350,000 cells per well. Using this model, it was possible to quantify the influence of chitosan on osteoprogenitor differentiation and osteogenesis. Experimental wells were pretreated with 200 μl chitosan (2 mg/ml in 0.2% acetic acid vehicle). Control wells were pretreated with 200 μl vehicle (0.2% acetic acid) or remained untreated. Cells were allowed to grow under optimal conditions for 14 days. Cell cultures were fixed with glutaraldehyde and stained with Von Kossa stain to identify bone forming colonies. Positive staining colonies were identified and counted under light microscopy. Histologic cross‐sections of representative positively stained colonies identified osteoblasts and confirmed bone formation. Examination of control wells revealed 3.6 ± 0.6 colonies per well while experimental wells revealed a significantly greater average of 6.2 ± 1.2 colonies per well (P≤ 0.01). Computer‐assisted image analysis of the average area of bone formed by control colonies was 0.34 ± 0.09 (relative units) while that of experimental colonies was 0.39 ± 0.06 (relative units) per average bone forming colony. The difference in mean size (control versus chitosan bone forming colony) was not statistically significant (P= 0.4691). The results of this in vitro experiment suggest that chitosan potentiates the differentiation of osteoprogenitor cells and may facilitate the formation of bone.J Periodontol 1996;67:1170–1175.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1170

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

The present study evaluatedthe clinical response of periodontal pockets in beagle dogs after treatment with a biodegradable delivery system containing 10% doxycycline hyclate (ABDS‐D). Eight adult, female beagle dogs had generalized, severe periodontitis with plaque and calculus‐laden pockets. In each animal, 3 teeth with multiple pocket sites ≥ 4 mm (mean depth = 6.0 mm) associated with attachment loss (mean = 5.4 mm) and which bled on probing (mean score = 2.5) were treated with a single application of either ABDS‐D (experimental group) or the delivery system alone without the doxycycline (control group). Residual polymer was removed at day 7. Bioassay of doxycycline in gingival crevicular fluid associated with presence of ABDS‐D gave mean levels of bioactivity of approximately 250 μg/ml. Levels of bioactive doxycycline were detected for approximately 7 days after ABDS‐D removal. Periodontal maintenance consisted of thrice‐weekly toothbrushing the treated sites. Clinical responses were evaluated at 2 weeks, and at bi‐weekly intervals thereafter for 4 months. Analyses of the data from the control group showed that there was only slight clinical improvement. In contrast, in the experimental group, bleeding on probing and probing depths were significantly reduced from baseline at all post‐treatment time points. At 1 month, mean probing depth reduction was 2.4 mm and this was maintained at 4 months (mean reduction = 2.5 mm). These probing depth reductions occurred primarily through gain of clinical attachment which was 2.0 mm at 4 months. Bleeding had been virtually eliminated (mean = 0.2). It was concluded that, for the beagle dogs with severely infected periodontal pockets in this study, treatment with subgingival doxycycline using the delivery system resulted in substantial improvement in periodontal health.J Periodontol 1996;67:1176–1184.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1176

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Periodontal disease is more prevalentand more severe in diabetic than in nondiabetic individuals but the magnitude of this increase is still being debated. This prospective, cross‐sectional study compared the periodontal status of 118 diabetic men and 115 age‐matched non‐diabetic men. Plaque and gingival indices, bleeding scores, probing depth, losa of attachment, and number of missing teeth were measured in a blinded manner. Smoking status, glycemic control, socioeconomic status, and previous dental care were also assessed. These parameters were significantly higher in diabetic than non‐diabetic men: plaque index,P<0.0001; gingival index,P<0.0002; bleeding score,P<0.0001; probing depth,P= 0.0059; loss of attachment,P<0.0001; and missing teeth,P<0.005. These parameters were significantly higher in smokers than non‐smokers: gingival index, probing depth, and loss of attachment. The duration of diabetes was not significantly related to the periodontal measures. Glycemic control as assessed by fasting plasma glucose and glycohemoglobin values was not significantly correlated to periodontal status. These studies indicate, for this study group, that diabetes significantly affects all measured parameters of periodontal status.J Periodontol 1996;67:1185–1192.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1185

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

The objective of the study was toevaluate bacterial colonization of the toothfacing surface of bioabsorbable membranes and to determine its effect on the clinical outcome of membrane supported reconstructive periodontal surgery. Twenty systemically healthy subjects affected by chronic adult periodontitis were enrolled in the study. One non‐furcation tooth site perpatient, associated with an angular bony defect and a probing attachment loss of>5 mm, was selected to be treated by means of a guided tissue regeneration procedure using a polyglicolactic membrane. Antibiotics (amoxicillin/clavulanate potassium 1 g per day) for 2 weeks were prescribed, in addition to the use of chlorhexidine for post‐surgical plaque control. All patients were recalled once a week for 5 weeks for professional tooth cleaning. At 5 weeks sites with clinically exposed membranes underwent a second surgery to harvest residual barrier material which was analyzed by scanning electronic microscopic (SEM) for bacterial colonization. Sites with no membrane exposure at 5 weeks were allowed to heal without any other surgical intervention. Professional tooth cleaning and reinforcement of self‐performed oral hygiene measures were given at 1 month intervals for the duration of the study. For each treated site the difference in probing attachment loss between baseline examination and a follow‐up examination made 6 months after the second surgery was calculated. Gain of probing attachment was statistically (P<0.001) greater in sites with no membrane exposure when compared to sites with partially exposed barrier material (4.2 ± 0.5 vs. 3.3 ± 0.6). The results of SEM analysis revealed that bacterial colonization was evident in all the microscopic fields of the exposed areas of the membranes. In the mid‐part of the membranes 16 out of 39 microscopic fields (41%) demonstrated microbial colonization, while no bacteria‐positive field was observed in the most apical portion of the membranes. Regression analysis indicated that gain in probing attachment level was negatively correlated to microbial colonization of the mid‐part of the membranes. It was suggested the midportion of the tooth‐facing surface of polyglicolactic membrane is a critical area for the healing process since its bacterial colonization was detrimental to the outcome of the GTR surgery.J Periodontol 1996;67:1193–1200.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1193

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

CyclosporineA (CsA)and verapamilare two agents used in renal transplantation, both of which are suspected of inducing gingival overgrowth. This study was conducted to investigate the effect of verapamil on the severity and prevalence of CsA‐induced gingival overgrowth. Fifty‐one (51) renal transplant recipients (total group) of whom 22 were using only CsA (Group A) and 29 of whom were prescribed CsA + verapamil (Group B) were evaluated for various periodontal and pharmacological parameters. No statistically significant differences were found in age, sex, plaque index, gingival index, calculus index, probing depth, CsA oral dose, CsA whole blood level, duration of CsA therapy, azathioprine dose, and prednisolone dose. Although the prevalence of the gingival overgrowth was more pronounced in CsA + verapamil group compared to CsA group (51.72% vs. 40.91%), the difference was not statistically significant. Similarly, the severity of gingival overgrowth, although more manifest in CsA + Verapamil group than CsA patients (34.24% vs. 28.91%), was not significantly different. Gingival overgrowth scores in the main group, CsA, and CsA + verapamil groups were found to be positively correlated to periodontal probing depths (r = 0.60, r = 0.70, r = 0.52, respectively) and the gingival index (r = 0.60, r = 0.70, r = 0.54, respectively). CsA oral dose, whole blood level, and duration of CsA therapy were not found to be correlated with the gingival overgrowth in either group. Likewise, the dose of verapamil and the duration of verapamil therapy were not correlated with the gingival overgrowth in Group B. This study indicates that verapamil, when prescribed as the calcium channel blocker in renal transplant patients, has no augmenting effect on the severity and the prevalence of CsA‐induced gingival overgrowth.J Periodontol 1996;67:1201–1205.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1201

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Chronic renal disease is associatedwith well‐documented impairments in polymorphonuclear leucocyte (PMN) function. PMNs are important in defending the periodontium against plaque infections. This report discusses a case of periodontitis in a patient with chronic renal failure. It presents treatment provided and 1‐year follow up. It shows that periodontal infections in patients with depressed PMN function could still be managed successfully with standard periodontal treatment emphasizing plaque control.J Periodontol 1996;67:1206–1209.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1206

出版商:Wiley    

年代:1996

数据来源: WILEY

摘要:

Rapid and severe destructionof periodontal tissues in early childhood has been reported both in systemically healthy children and in children with systemic disorders. In this study, the clinical and immunological findings of two siblings in a family with Papillon‐Lefèvre syndrome are presented. The peripheral blood lymphocytes were analyzed using a double colored flow cytometry and adequate monoclonal antibodies to CD2, CD3, CD4, CD5, CD8, CD11b, CD16, CD19, and HLA‐DR receptors. CD11b expression was found to be higher in both siblings (35% and 37%). The elevated CDllb expression may be related to a defect in neutrophils. The expression of natural killer cells was found to be higher in one patient but the results were in normal range. The CD2+, CD3+, CD4+, CD5+, CD8+, and CD19+ lymphocytes were in normal range in both patients. We think that the depressed chemotaxis of peripheral neutrophils, and higher expression of HLA‐DR and CD11b molecules in peripheral leukocytes were useful in explaining the pathogenesis of the Papillon‐Lefèvre syndrome.J Periodontol 1996;67:1210–1215.

ISSN:1049-8885    

DOI:10.1902/jop.1996.67.11.1210

出版商:Wiley    

年代:1996

数据来源: WILEY